Signs of alcoholic hepatitis of the liver and methods of treatment. Alcoholic hepatitis: diagnosis, symptoms, treatment

Alcoholic hepatitis is an inflammatory process. It occurs against the background of a large consumption of alcoholic beverages. As a result of this, the body is affected by toxins. The chronic form of the disease occurs 5-7 years after the onset of the inflammatory process. The scale can be serious, it all depends on the quality of alcohol consumed and its quantity.

ICD-10 code

For convenience, a special international classification of the disease was created. Thanks to it, you can understand the diagnosis made anywhere in the world. Simply put, this encoding is used everywhere. Hepatitis is one of the diseases of the digestive system.

K00-K93 Diseases of the digestive system. . K00-K14 Diseases of the oral cavity, salivary glands and jaws. K20-K31 Diseases of the esophagus, stomach and duodenum. K35-K38 Diseases of the appendix [vermiform appendix]. K40-K46 Hernias. K50-K52 Noninfectious enteritis and colitis.

K55-K63 Other bowel diseases. K65-K67 Diseases of the peritoneum

K80-K87 Diseases of the gallbladder, biliary tract and pancreas. K90-K93 Other diseases of the digestive system

K70-K77 Diseases of the liver.

• K70 Alcoholic liver disease (alcoholic liver disease, liver cirrhosis).
  • K70.0 Alcoholic fatty degeneration of the liver.
  • K70.1 Alcoholic hepatitis.
  • K70.2 Alcoholic fibrosis and sclerosis of the liver.
  • K70.3 Alcoholic cirrhosis of the liver.
  • K70.4 Alcoholic liver failure (Liver failure).
  • K70.9 Alcoholic liver disease, unspecified
• K71 Toxic damage to the liver.
• K72 Liver failure, not elsewhere classified. (Liver failure).
• K73 Chronic hepatitis, not elsewhere classified. (Chronic hepatitis).
• K74 Fibrosis and cirrhosis of the liver (cirrhosis of the liver).
• K75 Other inflammatory diseases of the liver.
• K76 Other diseases of the liver.
• K77 Liver disorders in diseases classified elsewhere

ICD-10 code

K70.1 Alcoholic hepatitis

Causes of chronic alcoholic hepatitis

The name speaks for itself. The main cause of liver problems is heavy alcohol consumption. The systematic intake of alcoholic beverages in an increased amount will sooner or later affect the condition of the liver. Alcohol contributes to the disruption of the oxidative processes of cellular structures. It has a toxic effect and disables the body. Eventually, cirrhosis of the liver may develop, requiring a liver transplant.

The minimum amount of alcohol that can lead to inflammation is 20-30 grams regularly. This figure refers to the female population. For a man, it is slightly higher and amounts to 60-70 grams per day. As can be seen from these statistics, it is not enough a large number alcohol to get into serious problems. There are simply no other reasons contributing to the development of inflammation. It's all about alcohol. Therefore, its consumption should be kept to a minimum.

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Pathogenesis

The toxic effects of ethanol lead to dependence. Ethanol has a particular effect on the concentration of acetaldehyde and acetate in the blood. The oxidative process increases NAD*H / NAD+ levels. It is these indicators that play an important role in the formation of fatty degeneration of the liver. As soon as the concentration of the first indicator increases, there is an increase in the synthesis of glycero-3-phosphate. As a result, fatty acids begin to actively accumulate in the liver.

Acetaldehyde has a hepatotoxic effect. It manifests itself mainly due to the intensification of lipid peroxidation processes. Ultimately, the functions of cell membranes are disrupted. In the complex of acetaldehyde with proteins, it leads to a change in the structure of hepatocyte microtubules. As a result, the formation of alcoholic hyalgin occurs. Intracellular transport is disturbed, hepatocyte dystrophy occurs.

Increased formation of acetaldehyde leads to a decrease in the activity of mitochondrial enzymes. As a consequence of this, the synthesis of cytokines is significantly enhanced. Cellular immunity is significantly impaired. Ultimately, the liver is exposed to a strong negative effect. The inflammatory process begins, the functionality is undermined. As a result, alcoholic hepatitis develops, flowing into a chronic form.

There are different points of view regarding the terminology of this type of alcoholic liver injury. L. G. Vinogradova (1990) gives the following definition: “chronic alcoholic hepatitis” is a term that refers to relapses of acute alcoholic hepatitis that occur against the background of an incomplete previous attack of acute alcoholic hepatitis and lead to a kind of liver damage with features of chronic hepatitis.

Histological examination reveals two forms of chronic alcoholic hepatitis: chronic persistent and chronic active. Morphologically chronic persistentalcoholic hepatitis combines the characteristic features of alcoholic hepatitis with moderate pericellular and subsinusoidal fibrosis in the third zone of the acinar hepatic lobule, expansion of the portal ducts, portal fibrosis, and slight portal infiltration. In the clinical picture, there is a decrease in appetite, mild pain in the liver, belching, general weakness, a slight enlargement of the liver, a mild increase in the activity of γ-glutamyl transpeptidase in the blood serum.

Chronic alcoholic active hepatitis histologically combines signs of alcoholic hepatitis with active fibrosis and hyaline necrosis in the hepatic lobules, bridging and multilobular necrosis is possible with a high activity of the pathological process. Clinical manifestations are characterized by severe weakness, lack of appetite, pain in the liver, jaundice, enlarged, dense and painful liver, significant changes in liver function tests, in particular, high activity of γ-glutamyl transpeptidase, aminotransferases in the blood serum, an increase in the blood level of immunoglobulin A.

Chronic alcoholic hepatitis can progress to cirrhosis of the liver even in conditions of abstinence from alcohol due to the addition of autoimmune mechanisms - sensitization of T-lymphocytes to alcoholic hyaline.

Chronic alcoholic hepatitis is a liver disease. Naturally, caused by a large consumption of alcoholic beverages. This disease must be eliminated, because, in most cases, it flows into cirrhosis of the liver. During the intake of alcoholic beverages, acidaldehyde is formed in the liver. It is he who strongly affects the liver cells. It is able to launch a series of chemical reactions and thus lead to organ damage.

Symptoms of chronic alcoholic hepatitis

The clinical manifestation of this disease is limited to meager symptoms. So, the organ may slightly increase in size, while pain appears. Severe pain, lack of appetite is not ruled out. Over time, the symptoms are supplemented by nausea and vomiting. There are no physical data.

Often there is a violation of the rhythm of sleep and wakefulness. A person has a decrease in libido, an increase in body temperature is noted. A number of other signs can be identified. So, the nails become white, spider veins appear, palmar erythema and ascites often develop. These changes are characteristic directly for the chronic form of the course of the disease. The symptoms described in the first paragraph appear at the initial stage.

The chronic course is characterized by the severity of symptoms, as well as their diversity. They may well appear at the same time. If treatment is not started on time, a fatal outcome is not ruled out. This happens due to the rapid development of cirrhosis of the liver. Severe liver damage requires liver transplantation. The risk factor is present in people with low weight, jaundice and increased liver density. Alcoholic hepatitis together with these factors is fraught with aggravating consequences.

First signs

The whole danger lies in the fact that for a long time the disease can be asymptomatic. Symptoms appear in severe stages. You can suspect something is wrong by violations of the liver. A person begins to feel weak, he has increased fatigue, appetite worsens, body weight decreases sharply. These are the first signs to look out for. Usually, pain syndrome doesn't really show up at this stage. Therefore, a person most often thinks that his condition is associated with a decrease in immunity and other diseases. He is in no hurry to visit the doctor.

Over time, the pain syndrome begins to manifest itself. To a greater extent, it is similar to discomfort and a feeling of heaviness in the right hypochondrium. Again, this situation does not really bother a person. After all, you can easily think that low-quality products were used. Alcoholics, as a rule, do not understand that all troubles arise against the background of uncontrolled drinking. Gradually, nausea, vomiting and a bitter taste in the mouth are added to all the symptoms. There may be an eructation with bitterness. This sign is associated with the use of alcohol and fatty foods.

Jaundice may also appear. An icteric shade of the sclera and membranes of the oral cavity appears. As the disease progresses, yellowness of the skin occurs. Sometimes itching is added to this, as well as an increase in the liver.

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Consequences

If the treatment was started on time, then there can be no consequences. In most cases, everything ends successfully. Subject to all recommendations and the exclusion of alcoholic beverages, there can be no consequences. Otherwise, the development of cirrhosis and fibrosis of the liver is possible.

Fibrosis is a reversible stage of the process. It can be eliminated with the right treatment. Cirrhosis cannot be cured, in this case, it is possible to get rid of the problem by organ transplantation.

If the treatment is started on time, and the transplant gave a positive result, then the prognosis will be favorable. But, in no case should you drink alcoholic beverages. Otherwise, there is a risk of re-inflammation. Therefore, you should always follow all the recommendations given and not deviate from them. Otherwise, death is not ruled out. Whether there are consequences or not, in most cases depends directly on the patient.

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Complications

It must be understood that this inflammatory process has disappointing complications. The fact is that in most cases hepatitis turns into cirrhosis of the liver. It is impossible to cope with the problem at the medical level. All that is needed here is a transplant. By its severity, cirrhosis is equated to a malignant tumor.

Ascites can be another complication. It is also caused by hepatitis. The main sign of a problem is a strong protrusion of the abdomen. This is due to the fact that in the human abdominal cavity there is a large amount of free fluid. The type of ascites is completely determined by the amount of that same fluid. With a small form, it can be 3 liters, medium - more than 3 liters. With a high form, the amount of liquid varies up to 20-30 liters. A person is not able to move normally, there are some difficulties.

It should be understood that ascites is an alarm signal. It indicates that the organ is not able to filter the blood. You can't miss this moment. After all, otherwise the patient will live no more than 5 years.

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Diagnosis of chronic alcoholic hepatitis

The first step is to collect an anamnesis of the disease and complaints. It is important to identify how long the symptoms began. Important information is the amount of alcohol consumed and its frequency. It is important to collect an anamnesis of life. Does the patient have any chronic processes in the body, are there any hereditary diseases. The presence of bad habits, tumors and contact with toxic substances are also taken into account.

Then a physical examination is performed. On examination, the shade of the skin, the size of the abdomen, and the presence of spider veins on the body are taken into account. On palpation, a person feels pain in the abdomen. Thus, you can also feel the enlarged organ. It is important to assess the mental state of the patient.

If necessary, an ultrasound is performed. The complete picture consists of laboratory studies, instrumental and differential diagnostics. Detailed information will be provided below.

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Analyzes

An important role is played by laboratory research. They include general analysis blood. Thanks to it, you can determine the level of red blood cells, as well as hemoglobin. It is easy, it turns out, to detect leukocytosis.

In addition to the general analysis, a biochemical blood test is given. It allows you to evaluate the functionality of the liver, pancreas. biochemical markers. According to them, blood coagulability indicators, the work of gamma-glutamyl transpeptidase are checked. Aliproprotein A1 is monitored. It can be used to determine the condition of the liver. If proline and hydroxyproline are significantly elevated in the blood, then, most likely, liver fibrosis occurs. This condition is characterized by the growth of scar tissue.

The coagulogram is also widely used. It is an analysis of the coagulability of blood systems. Lipidogram is a study of fat-like substances in the blood. It is possible to determine the long-term use of alcohol by laboratory signs. In humans, the activity of gamma-glutamyl transpeptidase, immunoglobulins, aspartate aminotransferase is significantly increased.

To get a complete picture, markers are defined. These are specific indicators that allow you to determine the presence of inflammatory processes in the liver that were caused by specific viruses. They also give a general urine test. It allows you to determine the general condition of the kidneys and urinary system. A coprogram is also carried out, in other words, an analysis of feces for the presence of undigested fragments of food and fat in it.

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Instrumental diagnostics

This research methodology is diverse. So, most often resort to the help of ultrasound. This will allow you to assess the condition of the abdominal organs and notice any changes in them.

Esophagogastroduodenoscopy is widely used. It is a diagnostic procedure during which the specialist manages to assess the condition of the esophagus as a whole. This allows you to identify pathologies. Inspection lends itself to the stomach and duodenum. The study is carried out using a special tool - an endoscope.

In addition, a needle biopsy is performed. For this, a damaged piece of the liver is taken and carefully examined. This allows you to assess the structure of the organ and make the correct diagnosis.

Helical computed tomography is widely used. This method consists in obtaining X-ray images at different depths. The study allows you to get an accurate image of the affected area. Magnetic resonance imaging has a similar effect. This technique is built on the chain of interaction between the human body and the liquid. It allows you to get a clear image of the organ under study.

Elastography. This technique allows you to examine the liver tissue. Everything is carried out using a special apparatus that allows you to determine the presence of liver fibrosis. During the procedure, a special compression of the tissue under study is carried out. As a result, you can see the changes. Most often, the procedure is used as an alternative to a biopsy.

Retrograde cholangiography. This technique is based on contrast management. It is usually introduced into Vater's nipple. The procedure allows you to determine the deterioration of the outflow of bile. Cholangiography is performed for people with severe cholestasis syndrome.

Differential Diagnosis

This type of diagnosis includes laboratory tests. Initially, a person needs to pass a general blood test, as well as a biochemical blood test. By the level of leukocytes, hemoglobin and erythrocytes, it is possible to determine the presence of abnormalities and the inflammatory process. Particular attention is paid to blood clotting.

In addition to this procedure, a biopsy is performed. It allows you to make a sample of the affected tissue and examine it. This technique is the most reliable, but only works in conjunction with blood tests.

To determine the state of the urinary system, a urine test is taken. It is important to determine the presence of markers. In addition, the stool is examined for the presence of coarse dietary fiber or undigested food fragments. It is impossible to get a complete picture by instrumental or diagnostic methods alone. All studies must be carried out collectively.

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Treatment of chronic alcoholic hepatitis

First of all, a person must refuse to take any alcoholic beverages. Naturally, for an alcoholic this is an unbearable burden. Therefore, it will have to be controlled. Because sooner or later all this will flow into cirrhosis of the liver. This is a very severe lesion, which most often ends in death.

It is worth visiting a psychologist and a narcologist. This will allow you to get rid of addiction and understand the severity of the whole process. Indeed, in most cases, a person is not able to cope with the problem on his own. All patients must strictly follow the diet number 5. Its purpose is to reduce the load on the diseased organ. That is why fatty, fried and spicy foods are among the forbidden foods. It is worth giving up salt, canned food, sweets and strong teas. Preference is given to food, which contains a lot of fiber, vitamins and minerals.

Naturally, it is impossible to do without medicines. True, in this case, you need to be extra careful. Because medications should have a positive effect on the body and not injure it. Most often, hepatoprotectors are prescribed. This is a group of drugs that are able to regenerate liver cells and protect it from negative effects. It is mainly recommended to use Ursosan, Essentiale N, Heptral and Rezalyut Pro. The course of treatment does not exceed one month. Detailed information about medications will be presented below.

It is important to fill the human diet with vitamins and minerals. Herbal teas, including those based on echinacea and mint, will be useful. If a person is pestered by an overexcited and stressful state, it is worth drinking a sedative. Valerian can act as it, but only in tablets! Tincture should not be used in any case! Enough 2 tablets 3 times a day. With severe liver damage, when cirrhosis is observed, it is worth resorting to organ transplantation. Otherwise, the person will not survive.

Medications

Ursosan. The dosage of the drug is prescribed by the attending physician. In especially severe cases, 14 mg per kilogram of body weight is used. The duration of therapy can be from one month to six months. In some cases, even 2 years. Contraindications: hypersensitivity, pregnancy, impaired liver and kidney function. Side effects: pain in the liver, nausea, vomiting, allergic reactions.

Essentiale N. The dosage is 2 capsules 3 times a day. The duration of therapy depends on the condition of the person. Contraindications: hypersensitivity. Side effects: extremely rarely, intestinal upset may occur.

Heptral. The drug can be used both in the form of tablets and injections. With prolonged therapy, the daily dose should not exceed 4 tablets. If the agent is administered, then 400-800 mg is sufficient. The duration of treatment is determined by the doctor. Contraindications: hypersensitivity. Side effects: heartburn, nausea, sleep disturbance, allergic reactions.

Resolution Pro. The drug is used 2 capsules, 3 times a day before meals. The duration of treatment depends entirely on the course of the disease. Contraindications: hypersensitivity, antiphospholipid syndrome. Side effects: diarrhea, allergic reactions.

Alternative treatment

Traditional medicine has a lot of useful recipes. Many herbs, fruits, plants and roots can be used for treatment. True, some of them can be toxic. Therefore, independent use can lead to a lot of unpleasant consequences. Before starting treatment, you should consult with a specialist.

Recipe 1. Blueberries. Long known beneficial features this berry. Its leaves contain special enzymes that help fight hepatitis. Many healers recommend using blueberry decoctions. You can use fruit drinks, juices and just eat the berry. Even jam will have a positive effect. The leaves themselves have special power. They are able to block viruses and protect the body.

Recipe 2. Pumpkin. It is useful with minerals and vitamins. Its pulp can be used both for treatment and just nutrition. It should be noted that it is not recommended to use it for more than 3 months. Traditional healers recommend using it fresh for about half a kilogram per day. You can cook porridge, stew it, and also eat it in the form of candied fruits. Of particular benefit is raw pumpkin along with sour cream. You can use pumpkin juice. Treatment with pumpkin is useful for cirrhosis of the liver.

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Herbal treatment

Medicinal herbs have a positive effect on many organs and systems. But, it is important to understand which of them can be used, and which ones should be avoided.

Recipe 1. Dandelion herb. With its help, many diseases can be eliminated. Especially those associated with liver failure. In the treatment of hepatitis, dandelion grass should be consumed fresh. Salads are fine. You can use jam from them. Dandelion has a choleretic effect. A decoction of it should be consumed before each meal, half a glass. It is prepared simply, dandelion leaves are taken and poured with boiling water. Then the tool must be allowed to brew and cool. The root of the plant is used to fight hepatitis. It should be crushed and evaporated for an hour. Then apply a tablespoon before meals.

Recipe 2. You need to take St. John's wort, calendula flowers, and chicory. Mix all this and take only 2 tablespoons of the collection. Then pour them with two glasses of cold water. Everything is infused all night, boiled for 5 minutes in the morning and filtered. You can drink the remedy regardless of the meal. The course of treatment is 2 months.

Recipe 3. Take the herb horsetail, yarrow and rose hips. It is important that everything is in equal proportions. After that, everything is mixed and only one tablespoon is taken. The collection is poured with a glass of boiling water and infused for 2-3 hours. You can use the resulting remedy 3 times a day 30 minutes before meals. The duration of treatment is 2 weeks. If necessary, the course is repeated after a month.

Homeopathy

Homeopathic remedies have always been in demand. True, they are not suitable for everyone. So, there are both positive and negative opinions about them. Among homeopathic remedies, only a few are able to help. So, the funds deserved special popularity: Hepel and Galstena. They have a positive effect, but only if applied under the supervision of an experienced homeopath. The main action of the funds is aimed at regenerating liver cells and creating a protective barrier around it. Drug therapy is long-term. It should be noted that monopreparations have always been distinguished by a special affinity for liver cells. Among them, it is worth noting May celandine and milk thistle. These two drugs are able to eliminate most of the symptoms that occur with liver damage. In addition, they support her.

The negative opinion is that not all people resort to the help of homeopathy. It's not like she can help everyone. The fact is that homeopathic remedies do not undergo any clinical trials, so it is difficult to say whether a positive effect will be observed.

Surgical treatment

Surgery refers to liver transplantation. This operation is not only difficult, but also expensive. Such an intervention is appropriate only if a person has cirrhosis of the liver or the last degree of liver failure.

High-quality transplantation can be carried out exclusively in German clinics. As mentioned above, the procedure is really expensive. The complexity of this operation lies not only in the price, but also in the search for a donor, because finding a person with good physical and mental characteristics is not always so easy. Some people stand in the "queue" for a new organ for years and do not always wait for it.

The operation itself is difficult. The recovery period is very long. It is necessary to monitor the condition of a person and an organ. After all, he takes root for a long time and this is not always possible. Naturally, it is best not to resort to such an operation. No one gives a 100% positive result. To avoid such a need, you should simply exclude alcohol consumption and treat pathological and inflammatory processes in the body in time.

Prevention

Prevention of alcoholic hepatitis is the only way to avoid this problem. After all, the treatment is not only long, but also difficult. Moreover, during the recovery period, many difficulties can arise. First of all, the consumption of ethanol-containing drinks should be excluded. In this case, we mean alcoholic beverages, of any percentage significance. The daily intake for a woman should not exceed 20 grams, and for a man 40 grams. If these figures are significantly higher, the likelihood of developing alcoholic hepatitis also increases.

The only way to avoid this problem is to avoid alcohol completely. If a person consumes it periodically, it is difficult to draw conclusions regarding his health. The development of alcoholic hepatitis depends entirely on the amount of alcohol consumed, the person's lifestyle and the nature of his diet. Naturally, a special place is given to the condition of the liver. Initially, it may not be at its best, and alcohol will only aggravate the situation.

Forecast

The prognosis depends entirely on the condition of the liver and the stage of development of the disease. The best prognosis is observed in the presence of alcoholic fatty degeneration. This condition is characterized by the presence of fatty droplets inside the liver cells. It happens under the influence of alcohol. Fixing this problem is not that difficult. Therefore, the prognosis is usually favorable.

A negative course is observed in cirrhosis of the liver. In this case, the problem can be eliminated only by means of transplantation. Medicines are unlikely to have the desired effect. With cirrhosis, the prognosis is poor.

A positive course is possible only if a person completely refuses to take alcohol and begins timely treatment of inflammatory processes in the body. Young age and normal body weight also affect the favorable prognosis. Finally, the disease proceeds much more favorably in men than in women.

Alcoholic hepatitis is a combination of degenerative and inflammatory processes that occur in the liver and are caused by the regular intake of large doses of ethanol.

The likelihood of developing ALD directly depends on the volume of consumed ethanol-containing drinks and the regularity of this process. At the same time, the type of alcohol is unimportant: beer, vodka, wine - all this creates a good help for the appearance of ABP.

Alcoholic hepatitis does not develop immediately: with regular use of critical doses of ethanol, the patient first develops fatty degeneration of the liver and only then alcoholic steatohepatitis. At the final stage, the disease flows into cirrhosis of the liver.

Reasons for development

The main cause of this type of hepatitis is the frequent use of alcohol. When it enters the body, only a small part (20%) is neutralized in the digestive tract and excreted by the lungs. The remaining amount of alcohol processes the liver. In this organ, alcohol is converted to acetaldehyde (a toxin) and then to acetic acid.

Note! With the abuse of alcoholic beverages, acetaldehyde accumulates in the liver cells.

This results in the following:

• the formation of fatty acids is disrupted;
• increases the production of tumor necrosis factors (inflammation appears);
• an increase in triglycerides.

The consequence of all these changes is the replacement of healthy cells of the organ with connective tissue: liver fibrosis develops. If treatment is not carried out, cirrhosis develops over time.

The following factors increase the likelihood of alcoholic hepatitis:

• taking a large number of ethanol-containing drinks at a time;
• the frequency and duration of alcohol consumption (the disease develops with its daily intake for 5-7 years);
• transferred viral hepatitis;
• genetic predisposition;
• malnutrition or malnutrition (leads to a deficiency of nutrients);
• excess weight;
• long-term use of drugs that have a toxic effect on the liver;
• the presence of autoimmune diseases;
• gender of the person who consumes alcohol: women are more likely to develop the disease.

Alcoholic hepatitis is conditionally divided into types. Criteria according to which it is classified:

• Features of manifestation. The disease happens:
  • sharp;
  • chronic.
• The severity of the pathology. The following degrees are distinguished:
  • light;
  • average;
  • heavy.
• The nature of the changes in the liver. Types of hepatitis:
  • persistent;
  • progressive.

It is impossible to determine the form of hepatitis on your own. But if you pay attention to the symptoms of pathology and undergo an examination on time, this will speed up recovery and reduce the likelihood of complications.

Symptoms of alcoholic hepatitis

Depending on the form of manifestation of the disease, the following symptoms of alcoholic hepatitis are distinguished:

1. persistent hepatitis: his symptoms are rather poor, the patient's condition is stable, heaviness in the hypochondrium on the right side, nausea, feeling of fullness in the stomach, belching is periodically noted. The patient may not be aware of the development of his disease. Sometimes it is revealed during the examination.
   In case of stopping the use of ethanol-containing drinks, stabilization and reverse development of changes in the liver are possible. With timely detection and implementation of therapeutic measures, observing a healthy lifestyle, hepatitis at this stage can be cured. With continued use of alcohol, the disease will progress.
2. progressive hepatitis observed in every fifth patient with alcoholic hepatitis. The disease precedes cirrhosis of the liver, the formation of areas of tissue necrosis (complete necrosis), an irreversible process. For progressive hepatitis, the following symptoms are characteristic: jaundice, pain in the hypochondrium, fever, vomiting, diarrhea.

Depending on the development and course of the disease, special signs of hepatitis are distinguished. The disease can be acute (icteric, latent, fulminant and cholestatic) and chronic. If the first symptoms are pronounced, pronounced (the patient may turn yellow, experience pain and deterioration), then the second may be asymptomatic and mild.

Acute alcoholic hepatitis

OAH, or acute alcoholic hepatitis, is considered a rapidly progressive disease that destroys the liver. It appears after prolonged drinking.

There are four forms:

1. Icteric - weakness, pain in the hypochondrium, anorexia, vomiting, diarrhea. In men, there is jaundice without skin itching, weight loss, nausea. The liver is enlarged, thickened, smooth, painful. The patient's hands tremble, ascites, erythema, bacterial infections, fever may appear.
2. Latent - diagnosed only by a laboratory method, biopsy, latent leakage.
3. Cholestatic - rare, symptoms are severe itching, colorless feces, jaundice, dark urine, impaired urination.
4. Fulminant - symptoms progress, hemorrhages, jaundice, renal failure and liver encephalopathy are observed. Due to coma and hepatorenal syndrome, death occurs.

Chronic alcoholic hepatitis

This disease may have no symptoms. Characterized by a gradual increase in transaminase activity with the dominance of AST over ALT. Sometimes a moderate increase in the indicators of cholestasis syndrome is possible. There are no signs of portal hypertension. The diagnosis is made morphologically - histological changes are characteristic, which correspond to inflammation, taking into account the absence of signs of the development of cirrhotic transformation.

Diagnosing alcoholic hepatitis is quite difficult, because. It is not always possible to obtain complete information about the patient due to obvious reasons. Therefore, the attending physician takes into account the concepts that are included in the definitions of “alcohol abuse” and “alcohol dependence”.

Criteria for alcohol addiction include:

1. The use of alcohol by the patient in large quantities and the continuous desire to take it;
2. Most of the time is spent on the purchase and consumption of alcoholic products;
3. Drinking alcohol in extremely dangerous doses for health and / or situations where this process is contrary to obligations to society;
4. Continuity of alcohol intake, even taking into account the aggravation of the physical and psychological state of the patient;
5. Increasing the dose of alcohol consumed in order to achieve the desired effects;
6. Manifestation of withdrawal symptoms;
7. The need for alcohol intake to subsequently reduce withdrawal symptoms;

A doctor can diagnose alcohol dependence based on any 3 of the criteria listed above. Alcohol abuse will be identified based on the presence of one or two criteria:

1. Alcohol use, regardless of the development of psychological, professional and social problems of the patient;
2. Re-use of alcohol in health-threatening situations.

Complications

Alcoholic hepatitis is dangerous in itself because of the risk of liver damage, but it can also lead to a number of complications:

• cirrhosis of the liver - scarring of tissues, wrinkling of the organ, violation of its functions;
• esophageal varices and bleeding from them is a life-threatening complication. Scar tissue in the liver interferes with normal blood flow, causing the veins in the esophagus to enlarge. If they rupture, the consequence may be death due to hemorrhage;
• encephalopathy due to the inability of the liver to process and remove toxins. This can lead to changes in mental state (confusion, overexcitation) and coma;
• ascites (abdominal dropsy) leading to compression and disruption of the internal organs. Up to 50% of patients die within two years.

Diagnostics

Diagnosis has certain difficulties. The mild course of the disease may not be accompanied by any specific symptoms, and it can be suspected only if changes in laboratory parameters are detected.

Laboratory signs of the acute form are leukocytosis, less often - leukopenia (with the toxic effect of alcohol on the bone marrow), B12-deficiency anemia, accelerated ESR, and an increase in markers of liver damage. Ultrasound examination of the liver reveals an increase in its size, heterogeneity of the structure, smooth contours. Magnetic resonance imaging (MRI of the liver) determines collateral hepatic blood flow, concomitant damage to the pancreas.

In the chronic form, an ultrasound examination of the liver reveals a slight or moderate enlargement of the liver, an increase in its echogenicity, and a uniform structure. Laboratory parameters changed moderately. A liver biopsy with alcohol damage reveals specific signs of inflammation, fibrosis, and necrosis. The severity of damage depends on the form of the disease and its duration.

How to treat alcoholic hepatitis

Treatment of alcoholic hepatitis in adults consists of the following "three pillars":

1. Exclusion of alcohol intake.
2. Dieting.
3. Medical therapy.

If necessary, treatment is supplemented by surgery (interventions).

Nutrition and diet

Fasting with hepatitis is contraindicated. The energy value of food should be at least 2000 calories per day for men and 1700 for women. Daily protein intake - at least 1 g per 1 kg of body weight, carbohydrate - more than 400 g, fat - less than 80 g. Products must necessarily contain many vitamins (especially group B, folic acid, the deficiency of which is always observed in alcoholics).

For hepatitis, diet No. 5 is prescribed. The patient can and should not eat the following foods:

Can

It is forbidden

Rye bread (yesterday's pastries); Products from lean dough (filling - boiled meat, fish, apples, cottage cheese); Milk soup with pasta; Soups on vegetable broths (cereals, cabbage soup, beetroot, fruit); Low-fat fish (fillet, baked, boiled, dumplings, meatballs); Poultry meat (fat-free, skinless, boiled poultry, beef, rabbit meat, turkey used in chopped or whole pieces); Milk sausages, children's sausage; Pilaf with a high content of carrots and boiled meat; Cabbage rolls; Dairy products (yogurt, kefir, low-fat yogurt, cottage cheese, low-fat, non-spicy cheese); Vegetable oil; Butter (in small doses); Cereals (oatmeal, buckwheat); Dried fruits; Krupeniki; Protein omelet without yolk; One yolk per day; Boiled, stewed or raw vegetables ( green pea, broccoli, boiled onions, carrots, beet); Boiled zucchini salads (zucchini caviar); Seafood (boiled); Fruits and berries (not sour, in the form of compotes, kissels, mousses, jelly); vegetable juices; Green tea; Rosehip decoction; Coffee with cream, milk; Spices, parsley, dill, sour cream sauce are allowed in moderate doses.

Sweet dough (products); fresh bread; Puff pastry; Fried pies; Soup (mushroom, fish broth, sorrel soup, okroshka); Fish (canned, fatty, smoked, salted); Meat (smoked meats, brains, kidneys, liver, fatty pork with streaks, lamb, poultry skin, goose, duck, fatty and smoked sausages); Fatty sour cream, fermented baked milk, cream, feta cheese, fatty homemade cottage cheese; Pig fat, lamb, chicken and mutton fat; legumes; Fried eggs; Radish, spinach, sorrel, garlic, green onions; Pickled vegetables; Mushrooms salted and pickled; Chocolate, cakes, pastries with cream; Horseradish, mustard, hot pepper; Strong coffee, strong tea; Complete exclusion of alcoholic beverages of any kind.

The diet is designed in such a way that it provides good nutrition, helps to normalize the process of the gastrointestinal tract and liver. Compliance with the diet guarantees the accumulation of glycogen in the liver, which leads to the normalization of fat and cholesterol metabolism. Bile secretion is well stimulated, and all activity of the gastrointestinal tract is normalized.

As a rule, the diet is prescribed not only at the time of treatment of acute forms of alcoholic hepatitis, in the treatment of cholecystitis, cholelithiasis, liver cirrhosis in the absence of liver failure, postoperative periods. The content of the complete diet of proteins, carbohydrates, restriction of fats and acids, essential oils, cholesterol-containing foods, products of fat oxidation during frying leads to great help to the body during the period of illness, remission is very useful.

The basis of nutrition is boiled food, in rare cases stewed. Products should be coarsely chopped, without grinding. Meat, fish in large boiled pieces, one at a time. The process of passerization of vegetables (sauteing) during the preparation of gravy, frying is excluded. Frying is completely excluded. Cold dishes and cold water should not be in the diet due to excessive irritation of the gastrointestinal tract, leading to a slow process of digestion.

Medical treatment

With alcoholic hepatitis, drugs are prescribed:

• suppressing stomach acidity: "Omeprazole", "Rabeprazole", "Pantoprazole";
• sorbents: "Polysorb", "Enterosgel";
• milk thistle and preparations based on it;
• hepatoprotectors: Heptral, Methionine, Glutargin. Essential acids of the "Essentiale" type - after the appointment of a hepatologist, gastroenterologist or therapist specializing in liver diseases;
• a short course - antibiotics such as "Norfloxacin" or "Kanamycin";
• lactic acid bacteria;
• lactulose preparations: "Normaze", "Dufalak" and others.

It should be noted that it is impossible to allow the development of constipation here: if the stool is delayed, you need to make an enema and increase the dosage of lactulose preparations.

Acute alcoholic hepatitis is treated only in a hospital.

Hepatoprotectors

There are 5 groups of hepatoprotectors:

1. Milk thistle preparations (Silimar, Sibektan, Karsil, Gepabene, Legalon) have a pronounced antioxidant (reduce the effect of oxidative processes) and immunostimulating effect.
2. Preparations with the active substance ademetionine (Geptral, Ademetionine) neutralize toxins, improve the outflow of bile.
3. Ursodeoxycholic acid from bear bile or the synthetic drug Worsan have a choleretic effect and antifibrotic effect.
4. Means of animal origin that stimulate regenerative processes in the liver (Sirepar, Hepatosan).
5. Products containing essential phospholipids (Essliver Forte, Essentiale Forte N) are one of the best medicines. They have an antioxidant effect, anti-inflammatory, increase the detoxification function of liver cells, stimulate the development of new cells.

Operation

In alcoholic hepatitis, palliative surgery can be performed. They alleviate the patient's condition, but do not eliminate the underlying problem. This:

• paracentesis - with ascites (accumulation of fluid in the abdomen);
• clipping (“stitching” with metal clips) of a bleeding esophageal vein.

These interventions are mainly used already at the stage of cirrhosis.

There is also a radical operation that solves the problem of liver cell death - this is a transplantation of a donor liver (more precisely, a section of the liver). Such an intervention can be performed in foreign clinics - for 150-200 thousand euros. It can be performed cheaper in domestic hospitals, but in this case, a long wait for such an operation is possible.

Prognosis treatment - how long do people live with alcoholic hepatitis?

Without treatment, the prognosis of alcoholic hepatitis is negative - life expectancy with toxic liver disease, according to pathological anatomy and pathology, depends on the individual characteristics of the organism, its endurance and the stage of the disease. With proper treatment, you can stop the problem and continue to lead a normal life, subject to the complete rejection of alcohol.

Unfortunately, patients suffering from the third stage of alcoholism continue to abuse alcohol after successful treatment of the disease and more than 30% of them die prematurely due to relapse and complications. Therefore, an important aspect in the treatment of liver disease is the preliminary treatment of alcohol dependence.

Prevention

Prevention of alcoholic hepatitis is the only way to avoid a long period of treatment and associated difficulties. First of all, it implies the rejection of the regular use of ethanol-containing drinks.

What is the acceptable daily dose of pure ethanol? For women, this figure is 20 g, for men the threshold is slightly higher - 40 g. Calculations must be made based on the fact that 1 ml of alcohol contains about 0.79 g of ethanol.

The best solution for people who seek to maintain their health is to stop drinking alcohol altogether.

Whether or not alcoholic hepatitis will develop in a person who periodically consumes alcohol depends on many factors: the amount of drinks consumed, lifestyle, heredity, diet, etc. In any case, it’s not worth the risk: if you don’t have enough strength to defeat alcohol addiction, you need to contact specialists and start complex treatment in a timely manner.

The traditions of the Slavs are the obligatory presence of strong drinks at the holidays. They entered our lives as elements of communication, meetings, small parties. Unfortunately, many people become addicted to alcohol, not knowing how to say “no” at the right time, to stop in time. And our liver is the first to suffer from such dependence. So how do alcohol and hepatitis C coexist? What is fraught with such a tandem? We learn the recommendations of immunologists, narcologists and hepatologists on this issue.

The effect of ethanol on body systems

The product itself is a toxin. Narcologists call it the most dangerous drug of all. This poison from the first minutes of entering the body begins its detrimental effect. Entering the digestive system, it negatively affects the gastric mucosa, gradually corroding it, thinning. Then the main antitoxic laboratory - the liver - is connected to the processing of alcohol.

The product of ethanol processing by this body is acetaldehyde. But the transformation process itself is so difficult for the liver that its cells are greatly weakened. They are trying to recover, to cure themselves. This is how liver scarring or inflammation occurs.

In the small intestine, the poison destroys the beneficial microflora and thereby disrupts the absorption of nutrients. With the blood, the breakdown products of strong drinks are carried throughout the body. The brain under their influence reduces the level of neurotransmitters. This is manifested by incoherent speech, decreased sensitivity, impaired coordination. With regular consumption of vodka and other types of alcohol, a person becomes less efficient, his memory, thinking, and ability to respond quickly in critical situations deteriorate. The personality turns into an individual, the addict degrades.

And the cells of the reproductive system suffer from alcohol: the functionality decreases, the structure is disturbed.

Illness and alcoholism

As you can see, all systems are subject to the negative influence of alcoholic products. According to statistics, hepatitis C occurs much more often in drinkers. This has been proven by studies that have established a direct relationship between the frequency of alcohol entering the bloodstream and various liver ailments. Alcohol in our blood increases the production of carcinogens. There is a direct link between alcohol dependence and the development of hepatocellular carcinoma (an irreversible oncological disease). And this disease can begin just with a viral disease.

Scientists in the last century came to the conclusion that a third of all chronic alcoholics develop cirrhosis and fibrotic pathologies. Representatives of the stronger sex over the age of forty are more susceptible to such changes, regularly (three times a week) consuming 150-250 ml of strong drinks of different strengths. It was also found that with diagnosed CHC, even in a young organism with good heredity, alcohol increases the risk of cirrhosis by 3 times.

So, popular and dangerous alcoholic products begin their destructive procession from the barrier organ.

Being unable to protect the entire body and process poisons, it suffers along with immune cells. The defenses simply cannot cope with the neutralization of the viruses that enter the body. The latter are multiplying. Their destructive influence increases the number of weakened cells. Cellular immunity drops to almost zero, namely protective properties CD8 and CD48 cells that resist viral agents. By and large, deaths from a viral disease occur when the liver fails.

That is why those infected who even periodically consume alcohol need to start an antiviral course on time. It is this category of patients that needs similar drugs to restore the liver to be cured.

Alcohol intake in the treatment of hepatitis C with sofosbuvir

Based on the foregoing, it is not difficult to guess that during the recovery period, the infected person should help himself as much as possible. That is, lead an exceptionally healthy lifestyle. Of course, no strong drinks, including low-alcohol ones, can be consumed categorically!

After all, both they and the viral disease, first of all, hit the liver. HCV is a destroyer of hepatocytes, turning the barrier organ into a weak, poorly functioning one. He, after the harmful effects of the virus, cannot do his job properly. Similarly, ethanol also affects hepatocytes, weakening and gradually destroying them.

So it turns out that the tandem of the virus and alcohol is a severe blow to a weakened barrier organ. The aggressive effect of alkaloids and RNA particles is a catalyst for scarring of soft tissues, the progress of fibrotic changes.

And the only right decision would be a complete rejection of alcohol-containing products for the period of the fight against a viral disease. That is, sofosbuvir and daclatasvir and alcohol are taboo!

It should be noted that not all doctors inform their patients about this. Hepatologists believe that all adults know how alkaloids destroy the body, the brain, that it is forbidden to drink during the antiviral (and other wellness course too).

But unfortunately, among sick men and representatives of the weaker sex, not all are responsible. There are many who simply ignore the rules of the antiviral course, thinking that small and infrequent portions of their favorite beer or wine will not hurt. For them, an exception to the rule in the form of three or two times for the entire course is absolutely normal. Some are sure that quality drinks are even healthy and permissible.

And in the end it turns out that it is impossible to achieve a stable virological response. And then such infected people begin to complain that the drugs do not help, which, for example, does not meet expectations. In fact, the reason for the ineffectiveness of the course is just the action of alkaloids.

Those who are about to enter therapy should be aware of what can happen if the prohibition is violated. This is fraught with the following consequences:

• Toxic lesions, because alcohol in small doses catalyzes negative reactions;
• Slowing down the secretion of bile and metabolic disorders;
• Jumps in blood pressure and deterioration of well-being;
• Rapid destruction of the liver, suffering from the combined aggressive action of RNA agents and alkaloids;
• Lack of effectiveness of treatment regimens, persistent virological response, relapses of the disease.
• Strengthening of the adverse reactions declared by manufacturers.

By the way, the latter is no less dangerous. After all, light "side effects" can go away on their own, and under the influence of alkaloids, light headaches can develop into migraines, moreover, frequent ones. Declared fatigue can be replaced by disability, and disorders in the gastrointestinal tract can develop into permanent diarrhea. An unpleasant phenomenon contributes to the leaching of not only nutrients, but also medicinal ones from the body. In other words, antiviral medicines will work in vain, and, in particular, a full course of the budget will be expensive. So the money will be wasted. It will not be possible to neutralize the pathogen virus and the doctor's efforts will be in vain. Are dubious holidays and fleeting pleasures worth it? Can I drink alcohol while treating hepatitis C? Of course not!

Responsible attitude to therapy, the desire to return to former activity as soon as possible - this is a ban on any kind of products containing ethanol.

High-quality, aged cognac is no exception in this regard. Both he and non-alcoholic beer can do a lot of harm. The latter is also because it contains many additives of synthetic origin. They also cause hepatocytes to become more active. Thus once again load these protective cells.

Can I drink after being treated for hepatitis C?

Recall that it is not very easy to neutralize viral agents and remove them from the body and this process is lengthy. If antibacterial drugs, for example, take 5-10 days, then antiviral drugs take several months. The success of the algorithm prescribed by the doctor must be confirmed by the final analyzes. The laboratory form indicates that the load is zero. The pills are stopped.

But does such a result mean that you can already afford culinary frivolities, rush to the gym again and gradually remember the taste of your favorite wine? Is alcohol allowed after hepatitis C treatment?

Immunologists explain: our body perceives any abrupt transitions from the usual style of eating and restrictions as a stress factor. And stresses are catalysts for relapses, that is, the return of the disease, the need for secondary recovery. Hepatologists say that all diseases of viral etiology greatly weaken the defenses, immune cells. Therefore, it is so important not to indulge in all serious, having a final analysis in hand. He does not give yesterday's patient a "green light" to renew his friendship with strong drinks.

Any drastic changes, extremes are not desirable in order to avoid relapses and waste of money on medicines. That is, after a twelve-week or longer recovery, for another 2-3 months, you need to follow the Pevzner style of eating and not drink vodka.

Responsible doctors strongly advise cured patients to visit the clinical laboratory again 30 days after stopping the pills. After all, not a single most experienced doctor will give his patient a full guarantee for a stable virological response, will not assure that the disease will not return.

By the way, hepatological statistics states that it is in the first three months that this probability is the highest. And any kind of alcoholic beverages consumed in moderate dosages can trigger a relapse.

It is worth noting that the popularity of non-alcoholic beer makes yesterday's patients of hepatologists return first to it. Typical mistake. After all, it is unlikely that a person will limit himself to one hundred grams of a popular drink; rather, he will drink a bottle. And it contains many synthetic components, which are processed by hepatocytes. This slows down full recovery. That is why low-alcohol products and high-quality strong ones can be dangerous in the post-treatment period.

Other Factors That Slow Recovery

The basis for the success of the treatment of diseases associated with the digestive system is a healthy diet. We are talking about the fifth table - the well-known diet of Mikhail Pevzner. Developed in the middle of the last century, it has helped millions of people to return to activity again, to feel all the charm of a full life. The basic rules of nutrition according to Pevzner are eating in small portions, often, with an emphasis on low-fat proteins, vegetables, and cereals.

Ignoring the diet, eating pickles and marinades, spicy and smoked foods, and fried foods can slow down recovery, fight the virus. Such food, like alkaloids, falls heavily on diseased hepatocytes, because their processing requires a lot of hepatic secretion - bile. It simply cannot be synthesized in sufficient quantities. This means that the incoming nutrients are not qualitatively recycled. In the stomach, it will ferment, rot, and a sufficient amount of vitamins will not enter the bloodstream. As a result of a negative phenomenon, the body does not have enough strength to fully recover.

When taking antiviral drugs, the loads of the physical plan negatively affect the body. Therefore, those who are accustomed to sports activities, carrying loads, weights, working in the field of physical labor should take this into account. Strong tension, firstly, takes away strength, and secondly, it compresses the internal organs, including the patient.

Emotional experiences are another factor hindering recovery. Indeed, during periods of stress, the weakest and most vulnerable systems of the body begin to work worse. If there are chronic diseases in the latent stage, exacerbations may occur. And when it comes to HCV and taking antiviral drugs, stress becomes a stupor in the cure. It also happens that strong experiences contribute to the mutation of pathogens. They become immune to the action of pharmaceuticals.

Cases are known when moral blows after a successful recovery catalyzed relapses. It is very difficult to learn to calmly react to such things, to abstract, to control emotions, but this is important.

Pharmaceutical agents also worsen the effectiveness of prescribed treatment algorithms, which cannot be combined with generics or other antivirals. These medications include:

• Medications to support the heart;
• Antacids;
• All medicines based on St. John's wort;
• sorbents;
• Antibacterial medicines;
• Anticonvulsants;
• antipyretic;
• Medications to support the liver.

Infected females should take into account that antivirals always reduce the effect of oral contraceptives and thus promote unwanted conception. And pregnancy during the period of taking such medications is not desirable.

Another factor that can greatly interfere with the fight against the virus is the intake of dioxides into the body. Such chlorine-containing substances are the final products of industrial production. Their person can inhale with air. They enter the bloodstream with bad water. There must also be high requirements for its quality during the therapy period. You need to drink purified water, avoid dubious sources. Moreover, drink a lot, helping to remove the remains of pathogens from the body during treatment with generics. Decoctions of herbs, juices, green tea will help with this.

Also, do not underestimate the dependence on nicotine as an inhibitory factor. The harmful substance inhibits the action of drugs from India for the treatment of HCV, which have proven themselves in the practice of Russian hepatologists. Smoking slows down recovery.

So, is it possible to drink during the treatment of hepatitis C and at the end of the healing process? Definitely not. Good health is worth it to go to any limits. Therefore, without willpower and self-control, the most effective pharmaceuticals, including Indian generics, will not help.

Alcoholic hepatitis is a pathological metamorphosis of the liver, with characteristic inflammation, fibrosis and fatty degeneration of the organ, caused by the toxic effect of alcoholic metabolites. If alcoholism is protracted, then the pathology is often transformed into cirrhosis. Alcoholic hepatitis is often characterized by both acute and chronic course of the disease. And the treatment of alcoholic hepatitis is reduced to a cardinal refusal of alcohol and the use of complex therapy.

In the international classification of diseases, the concept of alcoholic hepatitis was introduced in 1995. Since that time, the history of this disease has been available. Gastroenterologists consider this disease, like alcoholic fibrosis, the initial stage of such a pathology as cirrhosis.

It has already been mentioned that alcoholic hepatitis is a combination of inflammatory and degenerative processes in the liver, provoked by the abuse of ethanol-containing drinks. The likelihood of an illness is directly related to the amount of alcohol consumed and the systematic nature of this process. Also, in the development of pathology, the type of alcoholic beverage does not matter: vodka, wine or beer - is an excellent tool for the development of the disease.

Alcoholic toxic hepatitis occurs gradually: with regular intake of critical doses of alcohol, a person first develops fatty degeneration of the liver and only after that - alcoholic steatohepatitis. In the final phase, cirrhosis is diagnosed. The development of the disease on average lasts 5-7 years.

Etiology of the disease

The main cause of this type of hepatitis is alcohol abuse. So, metamorphoses in the liver of a man are observed with a systematic daily intake of 50-80 g of alcohol, in women - 30-40 g, and in adolescents - 15-20 g. When alcohol-containing drinks enter the body, only a small part of ethanol (up to 20%) neutralized in the gastrointestinal tract or excreted through the lungs. The rest is processed by the liver. It converts alcohol into acetaldehyde (a toxin) and then into acetic acid.

However, the abuse of strong drinks leads to the accumulation of acetaldehyde in the liver cells, which ultimately leads to:

• to an increase in the number of triglycerides;
• to disruption of the formation of fatty acids;
• increases the production of tumor necrosis factors (inflammation occurs).

The consequence of these metamorphoses can be called the replacement of healthy cells of the organ with connective tissue (fibrosis). If its therapy is not carried out, then it degenerates into cirrhosis. Also, the following factors contribute to the development of alcoholic hepatitis:

• excess weight;
• transferred viral hepatitis;
• hereditary predisposition;
• diagnosed autoimmune diseases;
• consumption of a significant amount of alcohol at a time;
• frequency and duration of consumption of ethanol-containing drinks;
• prolonged use of drugs that have a toxic effect on the liver;
• improper or insufficient nutrition, provoking a deficiency of nutrients.

In addition, the gender of the patient will also play a role - in women, the predisposition to the development of the disease is much higher.

Classification of the forms of the course of alcoholic hepatitis

Such an ailment may have a persistent or progressive development. The first case is characterized by a fairly stable form. However, if you stop drinking strong drinks with it, then it is most likely that liver cells regenerate. When the patient continues to abuse alcohol, the pathology becomes progressive.

Given the severity of the progressive form of alcoholic hepatitis, there are mild, moderate and severe degrees. A feature of the progressive form should also be called the formation of small-focal necrotic lesions, which often leads to cirrhosis. With adequate, timely treatment, the development of the disease can be stopped, but the residual effects will not go anywhere.

Along the course of the disease, chronic and acute alcoholic hepatitis are also isolated. The latter is characterized by progressive damage to the organ. Acute alcoholic hepatitis is found in 70% of people who drink with alcohol. In another 4% of these patients, the disease quickly transforms into cirrhosis of the liver. Acute alcoholic hepatitis can take the following forms:

• latent;
• icteric;
• cholestatic;
• fulminant.

The most severe cases of acute alcoholic hepatitis are often observed in cirrhosis after a long drinking bout.

Clinical manifestations

The latent type of the course of the disease does not have pronounced symptoms. Patients complain of some heaviness in the right hypochondrium, as well as slight nausea. This type of disease is detected thanks to laboratory tests (an increase in transaminases is noted). But the final diagnosis is made after a biopsy.

The icteric variant of the disease is found most often. The main signs of alcoholic hepatitis of this type:

• yellowness of the skin and sclera;
• pain on the right under the ribs;
• nausea, vomiting, diarrhea;
• palpable weakness;
• weight loss;
• anorexia.

It is also not excluded an increase in temperature, an increase and soreness of the liver itself. If the patient has tuberosity of the liver (with hepatitis it is smooth), redness of the palms and ascites, then we can assume the background development of cirrhosis.

Cholestatic hepatitis is not as common and has the following symptoms: severe itching of the skin, jaundice, dark urine and discoloration of feces. This type of disease is characterized by a protracted course. The fulminant type is characterized by rapid progression of hepatorenal and hemorrhagic syndrome and obvious changes in laboratory markers. In the case of hepatic coma and hepatorenal syndrome, a fatal outcome is not excluded.

If we consider chronic alcoholic hepatitis, then its symptoms are blurred. It is diagnosed by certain signs found during an organ biopsy, indicating the presence of inflammation, but the absence of cirrhosis of the liver.

Diagnostics

It is quite difficult to identify this disease. With a mild course of the disease, symptoms may be completely absent. In this case, clinical studies of the patient's biological fluids come to the rescue. Thus, an increase in the number of leukocytes, an accelerated ESR, an increase in markers of liver damage, as well as anemia provoked by vitamin B12 deficiency will indicate the acute stage of alcoholic hepatitis. A reduced concentration of leukocytes often occurs when toxins act on the bone marrow.

Ultrasound of the liver - a method for diagnosing alcoholic hepatitis

Ultrasound examination of the organ will show an increase in the liver, uneven contours with a heterogeneous structure. An additional MRI will also show damage to the pancreas. Ultrasound in the chronic form of the disease will help to identify a slight increase in the liver, its homogeneous structure and increased echogenicity. Blood tests will be uninformative.

Liver inflammation, fibrosis, and necrosis can be detected by biopsy. As a rule, if such symptoms are detected, the attending physician should clarify with the patient about his addiction to alcohol. However, such people rarely adequately estimate the amount of alcohol they drink, so it may be necessary to interview their loved ones as well.

Methods of treatment

Alcoholic hepatitis involves complex treatment. So how will specialists treat alcoholic hepatitis? First, it is necessary to eliminate the very cause of the development of the disease - ethanol-containing drinks. Often in a mild form of the disease, this will be enough for the liver cells to recover. With further use of alcohol, the disease will only progress. Secondly, drug therapy is prescribed. And, thirdly, the diet for alcoholic hepatitis also plays a significant role.

Drug Therapy Options

Drug treatment is reduced to the appointment of essential phospholipids. They contribute:

• regeneration of liver cells;
• decrease in the processes of fatty degeneration of the organ and inhibition of fibrosis;
• reduce the negative effects of alcohol on the body due to their antioxidant properties.

In the case of a cholestatic type of disease, drugs with ursodeoxycholic acid, which have a cytoprotective effect, can be prescribed. As for hepatoprotectors with silymarin, they are prescribed to block the synthesis of acetaldehyde, which damages cell membranes, and also because of their antioxidant properties.

In the acute stage of alcoholic hepatitis, detoxification therapy is mandatory, which involves intravenous administration of plasma substitutes and correction of electrolyte disturbances. Severe forms, in particular hepatocellular insufficiency syndrome, are treated with glucocorticosteroids. Treatment of the chronic form will be entirely determined by the degree of liver damage.

diet therapy

Most patients with alcoholic hepatitis show signs of malnutrition. And the more severe the liver damage, the more pronounced trophic insufficiency. Starvation with such an ailment should be excluded. It is very important that the total calorie content of the patient's diet does not fall below 2000 calories. At the same time, attention should be paid to ensure that the protein intake is 1 g per kg of the patient's body weight, and also that the menu contains a sufficient amount of vitamins (especially group B) and unsaturated fatty acids. As a rule, patients are assigned dietary table number 5.

Diet therapy - a method of treatment of alcoholic hepatitis

This diet is designed to not only provide good nutrition, but also normalize the digestive tract. Its basis is boiled, less often stewed, food. All products are cut quite large. Fried foods and sauces are excluded. Also in such a menu there are no cold dishes and drinks that can irritate the gastrointestinal tract. If the patient's condition is very bad (anorexia), then the patient is prescribed tube enteral or parenteral nutrition.

Possible complications and prognosis

The danger of alcoholic hepatitis lies not only in the destruction of the liver, but also in a number of related complications. Among them:

• cirrhosis of the liver: scarring, wrinkling of tissues, organ dysfunction;
• ascites (dropsy): compresses and disrupts the functioning of organs, due to which 50% of patients die within the next 2 years;
• encephalopathy: causes mental changes, can lead to coma;
• varicose veins of the esophagus and an increased likelihood of hemorrhage.

Without treatment, the prognosis for this disease is negative. How long a person will live will depend entirely on the individual characteristics of the organism, its endurance and the severity of the pathology. However, with proper treatment and the complete rejection of alcohol, the manifestations of the disease can be stopped and the patient can return to a normal lifestyle.

Prevention measures

Prevention of alcoholic hepatitis is the only way to avoid the disease. First of all, it comes down to avoiding regular alcohol consumption and not exceeding its minimum recommended daily doses (20 g for women and 40 g for men). However, it is best to avoid alcohol altogether. It must be remembered that the development of hepatitis, in addition to the systematic consumption of ethanol-containing drinks, is influenced by many other factors and, unfortunately, no one is immune from a combination of adverse circumstances.

Alcoholic hepatitis is a pathological process caused by heavy consumption of alcoholic beverages. When ethanol enters the body, along with other components of alcohol, acetalhyd is formed in the liver - a substance that damages the structure of the liver. A lethal dose for the male body is 40-80 gr. alcohol (2-3 liters of beer) and for a woman 30-40 gr. (1-2 liters of beer) With regular use of alcohol in such quantities, the chances of getting sick are 90%

According to statistics, you can get sick after 4-7 years of regular drinking. Acute hepatitis quickly flows into a chronic form and, with further development, transforms into cirrhosis, a disease whose prognosis is not encouraging.

Show all

How to identify an acute illness?

Symptoms of acute alcoholic hepatitis differ in the rate of development and severity. Most patients are males who have abused alcohol for 3-5 years. But sometimes a multi-day binge can speed up the process.

Acute alcoholic hepatitis symptoms:

• Nausea;
• Bitter taste in the mouth;
• Loss of appetite;
• repeated vomiting;
• High temperature (38 degrees);
• Severe pain in the right side, abdomen;
• Liquid stool. The consistency of feces changes - brightens, the smell is sharp, strong;
• Flatulence;
• Loss of sensation in the limbs, tip of the tongue;
• Lethargy, decline in performance;
• Mental disorders - increased irritability, aggressiveness, apathy, depression, anxiety, uncontrolled fear;
• Change in skin color, whites of the eyes to yellow after 2-3 days;
• An increase in the volume of the abdomen due to ascites - an excessive amount of fluid in the abdominal cavity.

Any sign lasts from 14 to 25 days. With this form of the disease, there is no obvious disruption of the gastrointestinal tract, an increase in the spleen. If not treated alcoholic acute hepatitis. jaundice will develop, liver failure, or the disease will transform into cirrhosis.



Symptoms of the chronic course of pathology

Chronic alcoholic hepatitis is characterized by slow development, it is difficult to cure. Appears against the background of long-term alcohol dependence.



In the initial stage, the disease is characterized by signs that appear randomly and weakly:

• Heaviness in right side;
• Sometimes sick;
• Belching with a taste of bitterness;
• Discomfort in the stomach.

If chronic alcoholic hepatitis is detected at this stage, the chances of a successful recovery will be high. This will require taking prescribed drugs, diet, and avoiding alcohol.

If there is no treatment after a few years, hepatitis becomes progressive, the risk of cirrhosis is observed in 30% of cases. Symptoms and treatment become more difficult. The patient's state of health deteriorates sharply, he is worried about:

• Profuse vomiting;
• Nausea;
• Chills;
• Jaundice;
• Attacks of acute pain in the right side.





Prognosis of life with illness

How long you will live depends on many factors. But if the disease did not have time to develop before cirrhosis of the liver, then you have every chance to live a long and happy life, subject to the conditions of treatment.



The chronic form at the initial stage is easy to treat. Liver cells are not strongly affected, there is no necrosis - cell death.

A prolonged, progressive form is dangerous for the development of necrosis, systemic dysfunction of the liver. Medicine has not yet come up with effective methods to return dead liver tissue. The more cells affected, the worse the prognosis.

With cirrhosis of the liver, they live 15-20 years - these are the highest rates. They can be achieved with strict adherence to the recommendations, systematic visits to the doctor.





Is the disease contagious?

The question of whether hepatitis is contagious and how long it will take for the development of the disease torments many. It's a shame to lead a healthy lifestyle, take care of yourself, and then at one moment discover this pathology of the liver.

Alcoholic hepatitis is only a consequence of chronic alcohol intoxication. But in some cases it is accompanied by a viral form A and B, which spread easily.



How does this happen? Virus agents are found in any biological fluid of the carrier - blood, urine, genital secretions, saliva. Infection occurs under the following conditions:

• During sexual contact. Probability 30-50%;
• When using non-sterile items - syringes, needles, manicure and pedicure tools;
• At birth, the baby also gets infections when it passes through the fallopian tubes.

If biological material the carrier does not get inside, but on the surface, what is the probability of infection? The risk of infection when the virus enters the skin and mucous membranes is 0.001%. Therefore, the patient should not be isolated.

But the use of common utensils, toothbrushes is not recommended. The saliva of the patient, along with particles of the virus, can get inside and lead to the disease.



The problem of nutrition and psychology of patients

Treatment of alcoholic hepatitis is based on the canons:

• Therapeutic diet No. 5, complete rejection of alcohol;
• Medical (hetaprotectors) and surgical intervention.



The treatment of alcoholic hepatitis carries two actual problems - nutrition, attitude towards alcohol. Only 1/3 of all patients refuse alcohol completely. The rest, due to physiological, psychological dependence, does not follow the recommendations. It is difficult to cure addiction, because due to the weakness of the liver, many neuroleptics are prohibited.

Patients with hepatitis do not eat properly. More than 50% of daily energy comes from alcohol. Often cases of malnutrition are identified.

Statistics show the positive effect of a protein diet on the condition of patients. If energy value the daily diet is 3000 kcal, and the protein on it is based on the weight of 1g / 1kg, then the success of treatment is 70-80%. If the calorie content of the daily diet is 1500 kcal and below, a positive outcome is only 20-30%.

Nutrition Features #5:

• Small portions (5-6 times a day);
• The liquid is taken separately from food. An hour before a meal or 30-40 after a meal.

What should not be on the menu:

• Meat, fish, mushroom broth. As well as soup cooked on it;
• Okroshka;
• Legumes in any form;
• Barley, millet, barley and corn porridge;
• Lentils;
• Pasta, spaghetti;
• Kidneys, liver, semi-finished meat products;
• Zhirov;
• Canned products;
• Salted, smoked, oily fish;
• caviar;
• Sushi;
• Shrimp, mussels, crab sticks;
• flour products;
• Salted cheeses;
• Fatty dairy products;
• Vegetables - corn, sorrel, spinach, radish, eggplant, bell pepper, garlic, onion, asparagus, cabbage;
• tomato paste;
• Most fruits / berries - figs, raspberries, cranberries, lingonberries, grapes, dates, kiwi, tangerine, oranges, pears, persimmons, apples;
• All types of nuts;
• Fried eggs;
• All sauces and spices;
• Kozinakov;
• Seeds;
• condensed milk;
• Halva.

What you can eat:

• Pureed vegetable, fruit, milk soups, as well as with cereals. Not in meat broth;
• Oatmeal, buckwheat, wheat and rice porridge with water and skim milk;
• Lean borscht with a minimum of cabbage;
• Souffle, casserole;
• Muesli without nuts;
• Lean meat and fish;
• Stuffed cabbage - not sour;
• Fresh oysters, squids;
• Bran/rye bread;
• Unleavened biscuits and bran;
• Fat-free yogurt, cottage cheese, milk, kefir;
• Steamed / baked vegetables - potatoes, broccoli, carrots, zucchini, pumpkin, beets, Chinese cabbage;
• Bulgarian pepper, cucumbers, tomatoes (limited);
• Banana, pomegranates, watermelon, melons, prunes, dried apricots;
• Fruit jelly, puree;
• Boiled eggs, steamed protein omelet;
• Salads from fresh vegetables with butter, fruit cuts;
• Zucchini caviar.



Medical solution

How to treat alcoholic hepatitis in the initial stages of development? When the disease is just developing, hetaprotectors are more effective - drugs that normalize liver function and help cells recover.

What hepatoprotectors are used today:

• "Heptral";
• "Essliver Forte";
• "Ursofalk";
• "Hofitol";
• "Ursodez";
• "Zadaksin"



The main active ingredients of hepatoprotectors:

• Milk thistle extract - supports liver function;
• Ademetionine - prevents further destruction of liver cells;
• Bear bile - increases the speed of recovery;
• Essential phospholipids - stimulate growth, help the liver recover.

The therapy also uses B vitamins and folic acid.

When the last stage of liver failure is detected, conservative treatment is useless, surgery is required. Surgical intervention consists in transplanting 40% of the liver from donors. The attending physician must select an appropriate donor, in good health. Preferably a blood relative with whom the chances of genetic identity are high.



Another difficulty is the cost and location of the operation.

Even if you have been diagnosed with alcoholic hepatitis, do not despair. There are thousands of cases of a favorable outcome, when patients have lived a long, full life. It all depends on you and your desire to get well. Follow the doctor's recommendations, take the necessary medications, and most importantly - do not lose heart, the psychological state also plays a big role in the favorable prognosis.